Current location - Trademark Inquiry Complete Network - Tian Tian Fund - How does the Medical Insurance Bureau investigate my accidental fall injury?
How does the Medical Insurance Bureau investigate my accidental fall injury?

The investigation is carried out by the county's New Rural Cooperative Medical Care Supervision Department. It asks relevant personnel at the scene at the time, or relatives who sent the patient to the hospital, or the specific location of the injury. After verification, reimbursement can be made if the conditions for reimbursement are met.

Conduct on-site surveys to understand whether reimbursement is included, and then determine the reimbursement ratio for trauma patients based on local population facts.

Accidental injuries involving the responsible party will not be reported. The New Rural Cooperative Medical System must eliminate these factors through investigation. Only when there is no compensation and the responsible party can it be reimbursed.

The Medical Insurance Bureau investigates how you were injured in an accidental fall. The details are as follows: 1. If the accident involved in the accidental injury is complex, serious in nature, and the claim amount is large, the insurance company will conduct an investigation, usually by entrusting an authoritative third-party professional investigation company. This is also to

Reduce the risk of claims settlement to avoid being defrauded; 2. The investigation is carried out by the county’s New Rural Cooperative Medical Care Supervision Department, asking relevant personnel at the scene, or relatives who sent the patient to the hospital, or the specific location of the injury. After verification, it meets the requirements

Reimbursement can be made according to the reimbursement conditions.

Conduct on-site surveys to understand whether reimbursement is included, and then determine the reimbursement ratio for trauma patients based on local population facts.

Accidental injuries involving the responsible party will not be reported. The New Rural Cooperative Medical System must eliminate these factors through investigation. Only when there is no compensation and the responsible party can it be reimbursed.

3. Door-to-door verification.

When trauma patients are hospitalized in medical institutions, they must pay the full amount of medical expenses in advance. They can only enter the medical insurance system for settlement after verification and confirmation that they fall within the payment scope of the medical insurance fund.

During the review, medical insurance agencies and medical institutions will require insured units, villages, public security departments, etc. to issue trauma certificates, explain the cause of the injury, and prove that there is no third party responsible before allowing them to enter the medical insurance system for settlement.

4. For accidental fractures, the investigation by the Medical Insurance Bureau is carried out by the county New Rural Cooperative Medical Care Supervision Department. The relevant personnel at the scene or the relatives who sent the patient to the hospital are asked about the specific location of the injury and what happened. After verification, it meets the requirements.

Reimbursement can be made according to the reimbursement conditions.

How to compensate for a work-related injury? The compensation you can get for a work-related injury includes: medical treatment for work-related injuries; the cost of installing assistive devices; the original salary and benefits remain unchanged during the period of suspension of work, and the employer pays them on a monthly basis, not exceeding 12 months; if the employee assesses the disability level, enjoy

Disability benefits; monthly living care expenses, the standards are 50%, 40%, and 30% of the average monthly salary of employees.

I hope the above content will be helpful to you. If you have any other questions, please consult a professional lawyer.

Legal basis: Article 12 of the "Social Insurance Law of the People's Republic of China" The employer shall pay basic pension insurance premiums in accordance with the proportion of the total wages of its employees stipulated by the state, and record them into the basic pension insurance pooling fund.

Employees should pay basic pension insurance premiums in accordance with the proportion of their wages stipulated by the state and record them into their personal accounts.

Individual industrial and commercial households without employees, part-time employees who have not participated in basic pension insurance in the employer, and other flexible employment personnel who participate in basic pension insurance shall pay basic pension insurance premiums in accordance with national regulations and record them separately in the basic pension insurance pooling fund

and personal accounts.

Article 60 The employer shall declare on its own and pay social insurance premiums in full and on time. Payment shall not be postponed or reduced except for legal reasons such as force majeure.

The social insurance premiums that employees should pay shall be withheld and paid by the employer, and the employer shall notify the employee of the details of the social insurance premiums paid on a monthly basis.

Individual industrial and commercial households without employees, part-time employees who have not participated in social insurance in the employer, and other flexible employment personnel can pay social insurance premiums directly to the social insurance premium collection agency.